To the Editor: Duke and colleagues recently reported the excess mortality and extra bed-days caused by intensive care access block in metropolitan Melbourne.1 Access block is an important patient safety issue, and we report here additional data that support their results.

The Australasian Clinical Indicator Report: 2001–2007, published by the Australian Council on Healthcare Standards (ACHS), reported that the national rate of intensive care access block was 5.9% in 2007, a statistically significant (P < 0.001) increase from 5.3% in 2001.2 There were large differences between states, with higher rates in Victoria in 2006 and 2007.

In 2007, the rate of cancellation or postponement of elective major surgery due to lack of intensive care beds was 3.1%, and the rate of interhospital transfer was 1.3%.2 Other rates reported were: the rate of discharge from the intensive care unit delayed more then 12 hours (16.6%) and the rate of after-hours (between 18:00 and 06:00) discharge (17.5%).2 The Victorian rate of after-hours discharge from the intensive care unit, calculated from seven participating hospitals in 2007 (21.6%),2 is comparable with the rate of after-hours step-down to a low-acuity ward found in Duke et al’s study — 18.6% for the period July 2004 to June 2006.1

The ACHS Clinical Indicator Program provides national and peer-group benchmarking to health services participating in its accreditation program, the Evaluation and Quality Improvement Program (EQuIP). Through its annual Clinical Indicator Report, the data are analysed and allow identification of unsatisfactory rates and wide variations in practice. Such national data can help health policymakers identify areas for potential improvement in the standards of health care delivery, particularly in areas where indicators address access. Duke and colleagues’ salient article illustrates the importance of such data being utilised for this purpose.